Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.
Chin Med J (Engl). 2013 Mar;126(5):855-9.
Recurrence of hepatitis B-related hepatocellular carcinoma (HCC) after curative resection is the leading factor influencing the prognosis of the disease. Therefore, further improvement of long-term survival may depend on the prevention and treatment of the recurrent tumor. The aim of this research was to investigate the role of antiviral therapy and postoperative transcatheter arterial chemoembolization (TACE) in the prevention and treatment of hepatitis B-related HCC recurrence.
One hundred and twenty patients who underwent curative resection of hepatitis B-related HCC between January 2005 and June 2008 at our hospital were enrolled. Patients were divided into four groups according to the post-operative adjuvant therapy they received, i.e., control, antiviral therapy group, TACE group, and combined group. The disease-free survival (DFS) and the 12-, 24-, 36-month cumulative recurrence rates were studied.
There was no significant difference between isolated postoperative antiviral therapy group and control in terms of disease-free survival (P = 0.283), while it was significantly higher in the TACE group compared to control (P = 0.019). In all patients, however, viral prophylactic therapy combined with/without TACE brought a favorable result compared to those only with/without TACE (P < 0.001). Similarly, no matter combined with or without antiviral treatment, postoperative TACE prolonged DFS (P = 0.015). Naturally, a combination of viral prophylactic therapy on the baseline TACE significantly benefited patients' postoperative DFS (P = 0.047) and vice verse (P = 0.002). The 24-month cumulative recurrence rates of combined group were significantly lower than that of isolated control group and antiviral therapy (P < 0.001 and P = 0.011 respectively). However, 36-month recurrence rate was significantly different in the control group compared to the TACE group and combined group (P = 0.040 and 0.002 respectively); same as the antiviral group compared to the combined group (P = 0.034).
Post-operative TACE prevents early recurrence while antiviral therapy prevents late recurrence of HCC. Combination of antiviral therapy and TACE are suggested for prevention in HCC patients with high risk of recurrence.
乙型肝炎相关肝细胞癌（HCC）根治性切除术后复发是影响疾病预后的主要因素。因此，进一步提高长期生存率可能取决于对复发性肿瘤的预防和治疗。本研究旨在探讨抗病毒治疗和术后经导管动脉化疗栓塞（TACE）在预防和治疗乙型肝炎相关 HCC 复发中的作用。
选取我院 2005 年 1 月至 2008 年 6 月期间接受乙型肝炎相关 HCC 根治性切除术的 120 例患者。根据术后辅助治疗，将患者分为对照组、抗病毒治疗组、TACE 组和联合组。研究无病生存率（DFS）和 12、24、36 个月累积复发率。
单纯术后抗病毒治疗组与对照组在无病生存率方面无显著差异（P = 0.283），而 TACE 组明显高于对照组（P = 0.019）。然而，所有患者中，病毒预防性治疗联合/不联合 TACE 比单独使用 TACE 效果更好（P < 0.001）。同样，术后 TACE 延长了 DFS（P = 0.015），无论是否联合抗病毒治疗。自然地，基线 TACE 联合病毒预防性治疗显著有利于患者术后 DFS（P = 0.047），反之亦然（P = 0.002）。联合组 24 个月累积复发率明显低于单纯对照组和抗病毒治疗组（P < 0.001 和 P = 0.011）。然而，36 个月时，对照组与 TACE 组和联合组的复发率有显著差异（P = 0.040 和 P = 0.002）；与抗病毒组相比，联合组也有显著差异（P = 0.034）。
术后 TACE 可预防 HCC 早期复发，抗病毒治疗可预防 HCC 晚期复发。对于复发风险高的 HCC 患者，建议联合抗病毒治疗和 TACE 进行预防。
